A Birth Fear Explained; The Peri Tear – Latest Evidence

Info to help you head into labour not worried about tearing but armed with the tools to best help minimise tearing and understand how best to manage and heal post birth.

Anecdotally when speaking with women about childbirth, in a professional setting or with girlfriends one fear brought up commonly is “I’m worried about tearing”. Now this is a totally valid feeling and fear, however this information should help you to understand how incredibly common (and often not that big of a deal) peri tears are.

Current research have the odds of sustaining a peri tear at around 85% (with the majority being low grade tears (defined below) and 0.6%-11% being the more severe ones (defined below).

In my opinion, women should head into labour not wanting to not tear (although, that is the ideal) but armed with the tools to best help minimise tearing and understand how best to manage and heal post birth.

What is the perineum? Where is the perineum?

The perineum is the area shaped like a diamond, that involves your vagina and anus. It involves the superficial and deep structures of that region.

What are the stats around tears?

The more babies you have the incidence of peri tears decreases. Perineal tears reduce from 90.4% in women who are first time mamas to 68.8% in women who are having subsequent babies.

Are there risk factors to perineal tearing?

Yes. There are maternal, baby and intrapartum risk factors to consider. The factors greatest in your control (remember birth is unpredictable and birth plans sometimes should be seen more as birth wishes…have your ideal plan A but also be open to B and C) are the intrapartum risk factors. These are the things that you can do during labour and birth to help minimise tearing.

Some of these risk factors (but not limited to) include:

  • epidural use (as this greatly restricts your movement)
  • use of oxytocin (statistically intervention leads to more intervention)
  • instrumental birth (vacuum or forceps)
  • episiotomy
  • prolonged second stage (>60 mins)
    ** the research within this study didn’t indicate whether this 60 minutes was a blanketed time for both first time mothers and/or mums of multiple babies. Some studies give first time mothers a longer second stage before considering it “prolonged”.**

Questions to discuss with your health practitioner antenatally?

  • Discuss what your hospital or care providers vaginal examination policy is.
  • Discuss birthing positions, use of water (does the hospital offer warm compresses?)
  • Discuss perineal massage antenatally and have a discussion around whether this is something that could be beneficial for you (we have a free how-to download here).

Grades of tearing?

Perineal tears are graded from a labial graze and then one to four.

The most common are labial grazes, 1st degree tears (shallow tear to the skin) and 2nd degree tears (tear to the skin and muscle).

3rd (3A,3B,3C) degree and 4th degree tears are not as common (these all vary in definition, but to keep it simple they involve a tear to the skin, perineal muscle, and/or internal and external anal sphincter muscles — a 4th degree tear, involves a tear into the anal sphincter.

What’s the latest evidence saying?

  • Current evidence published in 2020 (Pubmed), retrospectively studied 22,387 pregnant women, and looked at the association between the number of vaginal examinations during labour and perineal trauma. The study concluded that performing five or more vaginal examinations (VEs) during active labour is associated with an increased risk of severe perineal trauma (defined as grade 3-4).  [DOI: 10.1007/s00404-020-05552-z]
  • Lying on your side, kneeling, standing or being on your hands and knees when you give birth will help. If you want more info on birth positions, head over here and have a read.
  • Avoiding long stretches of time squatting, sitting, or using a birth stool when you are pushing – if you’re getting good comfort from these positions, just switch it up, rotate your way through.
  • Ask your midwife to hold a warm, wet compress (a sterile hospital washcloth) on your perineum while you are pushing. Research concluded from a randomised control trial looking at the efficacy of warm peri compresses whilst pushing that women reported less pain whilst pushing when using a warm compress, working as a pain relief.

‘The use of a warm of a warm pack failed to decrease the likelihood of a laceration requiring sutures, which occurred in about 80% of women in both groups…however…women (who didn’t receive warm compresses) were more than twice as likely to have an anal tear (8.7% vs. 4.2%)’.  – Dahlen et al.

It also was linked to less perineal pain in the days after birth, as well as less reported urinary incontinence reported three months post birth.

 

Healing after birth

  • Make sure your sutures are looked at by a health professional
  • Keep clean and dry
  • Use ice and pain relief to minimise swelling
  • Begin pelvic floor exercises as soon as possible in the days post birth
  • If you sustain a more substantial tear, it’s important to follow up and be referred onto a physio that specialises in women’s health.
  • If in doubt, and you have questions, speak to your midwife, obstetrician, or GP.

Continue reading “A Birth Fear Explained; The Peri Tear – Latest Evidence”

The Birth Story of Poppy

Like most midwives, I’d spent years thinking about my own birth. I wanted a calm, and empowering birth at home or in a birth centre. I knew it was going to be challenging, but I’d seen so many women do it before…

Like most midwives, I’d spent years thinking about my own birth. I wanted an easy (lol), calm, and empowering birth at home or in a birth centre. I didn’t want to use drugs, or have any kind of medical intervention. I knew it was going to be challenging, but I’d seen so many women do it before.

 

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At 40+3 weeks I decided to take things into my own hands and get this show on the road. My Virgo, perfectionist personality didn’t want a bar of my impending induction date. Id already done most of the induction things that women drive themselves insane doing to try and bring on labour naturally; acupuncture, curry, dates, sex, raspberry leaf tea tablets, long walks, stairs, self hypnosis, and four weeks of hand expressing colostrum. I’d had a few stretch and sweeps from my MGP midwife and the look on her face told me my cervix showing no signs of preparing itself to open up (posterior, high, hard, barely admits a finger – depressing to say the least). 

So I decided to try rubbing my nipples as a last ditch attempt to bring things on naturally. I couldn’t believe how effective it was. My tummy would go rock hard and actually start to contract. Hilarious and miraculous. That night I went to bed and knew I was going into labour. My waters broke in bed and I swear I heard them pop like they do in the movies. I was so excited and also had no idea what to do because I couldn’t stop laughing.

I remembered what I tell women to do when their waters break and I put on a pad and rang my midwife. All was going well. Until I rechecked my pad and realised my waters had a slight hint of green to them. My heart sank. I took a pic and sent it to my bestie Rosie (also a midwife, mum of two, aka Winnie Wagtail – what a woman). She replied straight away and confirmed my waters were mec stained. My baby had done her first poo and literally shat all over my home birth / birth centre plans. I called my midwife and we headed into the hospital. I had a VE in women’s assessment and my midwife confirmed that my cervix had still not made it to the party and was only 1cm. I was disheartened but tried to stay positive.

We got admitted to a delivery suite room with a bath and Stefan started setting up the room like all good hypnobirthing partners do. He turned the lights down, plugged in my Himalayan salt lamp and put my diffuser on. By this stage I was connected to a CTG and had my TENs machine working overtime. My contractions were amping up and my hypnobirthing affirmations were making me more and more furious. I knew I needed to calm down and try and stay in control but things were starting to feel more and more out of control. After a couple of hours of this i asked my midwife to check my progress. I thought maybe I was progressing so quickly that I was already transitioning and that’s why I felt so hysterical. Wrong. My cervix was still fast asleep. I ordered an epidural immediately. My baby was still posterior (as she has been the entire pregnancy), my back was in agony from her position and the parting words from my last ultrasound rang in my ears “your baby has a large cranium”.

My midwife Hannah rang the anaesthetic team and let them know I was requesting their assistance. When she hung up she started running me a bath. This was bad news. The anaesthetists were tied up in theatre with an emergency cesarean and the fact that Hannah was preparing me a bath meant they weren’t coming anytime soon. When you’ve spent hours trying to deal with the pain of labour on your own and finally decide to have a EDB, you want it immediately. Not in 10, 20 or 60 minutes later. I begged Hannah to tell me how long they’d be (which is ridiculous because I knew her guess was as good as mine). After 2 hours of thrashing around in the bath like a whale at a nightclub, and a second unexpected emergency cesarean for an undiagnosed breech delivery in labour ward (which delayed the anaesthetists once again), the consultant anaesthetist was called in from home. I demanded to know where she lived and how long it would take her to drive to the hospital. Hannah said she’d be about 20 minutes. 

When the anaesthetist finally arrived I waddled across the room and threw myself on the bed. I yelled at her I knew the risks and didn’t care about any of them (if you’re reading this, my sincere apologies). The epidural was the best decision I’d ever made, I was beyond thrilled (if you’re planning a hypnobirth please don’t let this deter you – this was just my experience). After 30 minutes of lying flat on my back to make the anaesthetic disperse evenly (an almost impossible task when you’re in labour), I was finally comfortable. Stefan immediately fell asleep and I convinced myself that I could now have a Kourtney Kardashian style birth (calm, epidural insitu and pulling my baby out of my vagina with my own two hands). 

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In the end I didn’t get my KUWTK style birth either. After 18 hours of contractions, syntocinon, vaginal examinations, a tachycardic CTG, and terrible jokes from my family who had arrived to lift our spirits, my cervix had only made it to 3cm. We decided to call it what it was (obstructed labour, failure to progress, fetal distress, and whatever other unsavoury terms you can think of) and headed to theatre for an emergency cesarean. I say “we” because my midwife and the obstetricians who were involved talked us through everything. In the end it was me who made the call to go to theatre two hours before they said we had to. I’d seen my situation play out before, my baby wasn’t happy, my cervix was as flexible as my birth plan (not at all) and I saw no point in carrying on for the sake of pushing my baby and body to its limits. 

So we headed off to theatre and it was horrific and beautiful all at the same time. I found it hard because as a midwife who had spent a lot of time in theatre receiving babies, I knew exactly what they were up to on the other side of the blue sheet. I knew which instruments were being used when and what bits they were pulling on and tearing.

On one hand I was scared and felt really out of control. But on the other hand it had all the elements of a birth I’d wanted, beautiful music (Neil Young’s Harvest Moon), my partner by my side, a baby whose lungs opened and worked as they were meant to when she took her first breath, and a supportive birthing team (the theatre staff really stepped up and proved themselves as a great substitutes to my family who were waiting back in the delivery suite). So while it wasn’t everything I had imagined (a spontaneous drug free BBA in the bath at home), it was still the best day of my life. 

 

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Poppy Rose Prosser was born on the 31/5/2019 at 18:02 at the Women’s and Children’s Hospital in Adelaide. 3570g of pure perfection ♡

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The Newborn Bubble: a balancing act during Covid-19

The newborn bubble is a special time post birth…isolation is a contributing factor to feeling unsupported. Medicare have rolled out a bulk billed service allowing you to connect with health practitioners from the comfort of home.

With Covid-19 being at the forefront of most people’s minds, for many women their pregnancy, birth and postnatal period are at the forefront of theirs. With the world slowing down, and retreating to their homes, hopefully mothers and babies will be able to “bubble” that little bit longer…with less visitors, less pressures to tidy the house, less pressure to get out and about.

I love the newborn bubble. The special time post birth when you and your new baby are learning each other, bonding and finding your way through breastfeeding, sleep (or sleeplessness), snuggles and the general explosion of love. The days blur into the nights, blurring into weeks; and for how hard it can be, it repays itself ten-fold in the love you uncover for this newbie that’s now in your world. I’m lucky enough to have felt this way throughout the early days of motherhood.

Now on the flipside of this potential benefit (a prolonged bubble) of Covid-19 is that isolation is a massive factor in contributing to feeling unsupported.  20% (1 in 5) of women will be clinically diagnosed with postnatal depression in Australia (according to 2010 stats), with more than half of these women being diagnosed in the perinatal period. It could be suggested though, that with this period of self-isolation, clinicians being stretched, and people being more hesitant to step foot into health clinics etc., diagnosis could be missed, and therefore mothers could unnecessarily suffer through an illness that seeks attention and help. It is important to remember that this is an illness and not a reflection on a mother personally, and there are ways to seek help, especially during times like now. Now more than ever, it’s the responsibility of family and friends to call to check in, with new mums.

The Australian Government, has funded a 100 million dollar Medicare service for people in home isolation, quarantine, or unable to attend a doctors surgery for whatever reason, that allows health consultations via the phone or video link through mediums such as Facetime of Skype to consult with the general public (specifically people deemed to be vulnerable or immunocompromised). It’s a completely bulk billed service provided by GPs, specialists, nurses, mental health and allied health workers.

This will be an incredibly important service for new mums, not only for the protection of their babies (staying out of doctors clinics unnecessarily) but ensuring fast, efficient and easy access to help, if required.

Pharmacies and e-prescribing services will be eligible to participate in the home medicine services (great for mothers if they were to get mastitis, etc.).

For more info: https://www.pm.gov.au/media/24-billion-health-plan-fight-covid-19

Signs and Symptoms
According to PANDA, The Perinatal Anxiety & Depression Australia organisation, a combination of the following symptoms for someone suffering from PND is not uncommon:

  • Sleep disturbance unrelated to baby’s sleep needs
  • Appetite disturbance
  • Crying or not being able to cry
  • Inability to cope
  • Irritability
  • Anxiety
  • Negative, morbid or obsessive thoughts
  • Fear of being alone or fear of being with others
  • Memory difficulties and loss of concentration
  • Feeling guilty and inadequate
  • Loss of confidence and self-esteem
  • Thoughts of harm to self, baby or suicide

Need help?
– Beyond Blue and their support service: 1300 22 4636

– PANDA

– How is Dad going?

– Black Dog Institute and a self-test

– How to get help
– Contact your GP

Articles about PND:
– Men just as likely to suffer PND 

– Postnatal Depression treatment at home a huge success

– Postnatal Depression Beliefs Confused

– https://www.aihw.gov.au/reports/primary-health-care/perinatal-depression-data-from-the-2010-australia/contents/summary

 

 

 

Test Yourself – the Covid-19 Challenge

Imagine if at the end of all of this, we emerge with a healthier attitude to self-care, mindfulness, and exercise; because if anything is to be learnt from this, it will be how much we have to value and protect our health at all costs.

In Australia, it’s really starting to sink in that we’re all going to be home, bunkering down, for quite some time. Nobody really knows how long and the unknown can be mentally incredibly tough to comprehend.

But what if this period of home-solation was actually a positive thing? Not the cabin fever or being (potentially) jobless or the extra kilos we all may be sporting on our hips when we re-enter life in the outside world, but the forceful nature of slowing down. An opportunity to reboot and reflect on what has gotten us to this moment in time, and to take more time focusing on our health and wellbeing.

2020 has seen bushfires, floods, and now a virus and we’re not even halfway through the year!Talk about a big F U from the planet –and maybe we deserve it? We haven’t been looking after Her, and maybe in a roundabout way, the Universe is sending us a message – maybe we need to focus on slowing down, self-care and our health, as we all know, when you’re feeling healthier you make healthier decisions, so maybe this will have a flow on effect? Cleaner living, cleaner lives, cleaner planet etc.

We all fly around the planet at a million miles per hour hoping to advance careers, get stuff done and yet anxiety, depression, obesity, mental health issues and lack of job satisfaction are at an all time high.

I saw a meme recently “Covid-19kgs heavier”, which is both hilarious and (scarily) possibly accurate. When it feels like the world is falling a part and we’re all stressed about our families, loved ones, finances, jobs and health, our anxiety levels increase and our bodies are working in fight-or-flight mode, our body’s natural stress response.

Adrenaline increases our heart rate, can elevate blood pressure and increases our stress hormone, cortisol. Increased stress and the immune system have been widely studied for many years and an interesting area to look into. A recurring attitude throughout many journal articles is that people under stress are more likely to have an impaired immune system. Something none of us want at any point, let alone at the moment.

The World Health Organisation is recommending for everyone at home to continue exercising and moving their bodies. They recommend 70 minutes of high intensity exercise every week or 150 minutes of moderate exercise each week.

150 minutes divided by 7 days is 21 mins…so instead of Covid-19kgs heavier, why not Covid-19 minutes of movement per day? This is so achievable for everyone (you can definitely do more than this, but it’s somewhere to start for those not moving at the moment), kids and adults alike. Throw some meditation in there too!

I recently read somewhere that kids won’t actually remember the virus, but only the time spent with family at home.  This is a perfect activity to do as a family (and a great way to add some structure to your days).

Imagine if at the end of all of this, we emerge with a healthier attitude to self-care, mindfulness, and exercise; because if anything is to be learnt from this, it will be how much we have to value and protect our health at all costs.

Here are some local business adapting to the current climate, making working out at home easier with some freebie trials, or low cost classes (and no lock-ins so you can jump about and/or try before you buy lots of different programs)

 Please tag and shout out local businesses that we can support that will help us stay healthy at home! We’ve tagged a few that we know are doing great things!

LOCAL TO BRISBANE

  • Studio 99 App– free download and access to home bodyweight workouts
  • Unplugged yoga in Paddington are doing online classes $5 per week

NATIONALLY

  • Emily Skye Fit – usually offers a 7-day free trial and has extended that to a free 30 days, which includes full length home exercise routines, booty challenge and healthy recipes. Enter code WHESF1M

INTERNATIONALLY

  • Insight Timer- Free app that has guided meditations for all levels
  • Melissa Wood Health – Free 7 day trial on her at home workouts, power flows and meditations. She has an app, and lots of workouts of varying lengths.

 

 

Birth Story: Baby P

A midwife shares her complicated pregnancy journey and the lessons learnt along the way.

An old colleague of mine sent me her birth story recently. Here’s a midwife’s perspective on the birth of her beautiful baby girl.

 

I debated about whether to share this, but realised that sometimes it is cathartic to express yourself after going through a stressful time.

Basically, I started off with a VERY complicated pregnancy. I’m not going to go into details here, but it required hospitalisation and a lot of time off work until 20 weeks. Being a first time mum and a midwife, I found this time very hard mentally. I think many first time mums focus on the birth and concerns about that, but I was NEVER concerned about the birth. Being a Birthing Unit midwife means that I am well informed and would have been confident to make the best birthing decisions given whatever circumstances came my way! Ideally, I would have wanted a natural drug-free birth (while always being open to pain relief if I needed it), but my main concern would always have been the safety of my baby. From a midwife’s perspective of not always seeing happy stories, and a history of anxiety, I was burdened with worry from the beginning about getting through a pregnancy safely. 35 weeks + 5 days is a LONG time to be feeling constantly worried.

I had a few weeks where everything was going smoothly. I was having regular scans, and then at 29 weeks we found out that our baby had asymmetrical IUGR (intrauterine growth restriction). This means that the baby isn’t growing properly for gestation. I was at least thankful that it was the asymmetrical kind – if you have IUGR this is the one you want! It means that the placenta isn’t functioning optimally to provide nutrients, but the baby is preserving brain/head growth, resulting in other areas such as the abdominal circumference not growing well. The baby had dropped from having her abdomen growing at approx 40% to 3% in a matter of 3 weeks – so pretty drastic!

Being a full time midwife while having a complicated pregnancy is HARD. I know work is hard for anyone who is pregnant and working shift work or a physical job (or any job at all), but it is harder with complications! I was so thankful to have my manager and colleagues support me where possible. However, it is SO strange to be treating women who may have come in with a growth restricted baby and concerns about their baby’s movement. Obviously, I didn’t share my own story with them for professional reasons, but on some really busy shifts where I was on my feet all day, it was hard to deal with. I hadn’t even had the chance to know if my baby had even been moving normally on those days (which is really important in the context of IUGR).

Towards the end, the plan for my birth had been an induction at around 37 weeks. I was covered with steroids to improve baby’s lungs (thankfully – given she ended up being born early by caesarean section).

Steroids are given in 2 doses 24 hours apart. I had these on a Friday and Saturday as well as having CTG monitoring of her heart rate – both days this was absolutely textbook perfect. On the Sunday we sold our car and were meant to pick up our new one on Monday. We joked with the friend we sold it to on Sunday that we hoped we didn’t need it for anything on that one night. Well, it turns out we did. At about lunch time I realised that I hadn’t really been feeling the baby move much. I lay down and prodded and poked her myself and nothing was happening. I was thinking to myself “am I imagining things? / I don’t want to go in to hospital to be annoying,” but ended up deciding to have a large coffee. If her movement wasn’t normal in an hour, I would call my midwife to go and get checked. We ended up getting an uber into hospital sooner than an hour due to my gut instinct that something wasn’t right.

I knew as soon as I was put on the CTG that the baby’s heart rate was a lot different to the two previous days, and was abnormal. I got scanned by a doctor and she wasn’t moving on ultrasound either, despite being prodded quite vigorously. The labour ward was busy that evening and the doctors had to come in and out, but I knew what was going to happen when I was asked “when did you last eat?” by the doctor. My midwife confirmed that the doctors wanted to do a caesarean section, and asked if I was ok with that. My response was “I just want my baby out safely”. My poor husband was a bit shell shocked. I think that I subconsciously knew what the outcome would be going in that day if everything wasn’t ok, but he was completely surprised and had to very quickly wrap his head around the idea that our baby was coming!

I’m so grateful that I knew the doctors who saw me/performed my caesarean from working with them previously – it made that part a whole lot easier for me!

As soon as our baby was born it was like instant relief for me mentally – I hadn’t quite realised beforehand the extent that the pregnancy had affected me. Since her birth I’ve felt amazing. She did have to go to the nursery for 9 days because she was a tiny 2.166kg, and also needed help with her breathing for the first 4 hours. I wasn’t worried about this at all, because again from experience I knew she would be absolutely fine, and my husband got to go with her to the nursery.

I was so grateful for the amazing support I got in hospital. I was expecting to not see her until the next morning when the anaesthetic had worn off and I could walk. However, the midwife looking after me arranged for me to get taken down in my bed at about 3am when she was off the breathing support, and we got to have our first cuddle. There is truly nothing better than the first cuddle with your baby!

Take home messages:

Maternal instinct is so important! I’m even more aware of how important fetal movements are after this experience. I went in 3 times in the pregnancy with movement concerns (while being a typical midwife and second guessing myself for fear of being annoying/creating a workload). I went in first at 26 weeks, and it was at the next scan that she was found to be IUGR. The second time was at 32 weeks after I’d had a lot of vomiting. I knew the reduced movements were dehydration related, but I still needed to get checked out. The third time was when she needed to be born!

I think more can be done to support the mental health of women with early pregnancy complications. It is a really lonely and scary time being in limbo.

I think there should be a discussion about leave entitlements for working women with pregnancy complications. I have always been vocal about maternity leave rights for women before I was even pregnant. We have created a capitalist society that requires 2 incomes to service a household, and for women to also support the economy. Women don’t choose complicated pregnancies. If women do have complications, I think there should be leave entitlements that don’t require them to use annual leave or leave without pay. I don’t buy into opinions of “it’s your choice to have a baby – deal with it”. As I’ve said before, there would be riots if women went on strike and stopped having babies.

Was my birth experience positive given the circumstances? YES! I feel like I recovered really well from the caesarean. The only thing I didn’t like was the spinal anaesthetic. The actual procedure was completely fine, but it is the weirdest feeling when you go completely numb from the waist down.

Would I do it all again for our daughter? YES!!!

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The Benefits of a Snuggle

Skin-to-skin explained

No doubt if you’re having a bub, someone will have mentioned the importance of skin-to-skin with you. And if they haven’t, you’re going to read about it now.

Skin-to-skin is literally that. It’s the newbie nudie on your chest, your partners chest, the new baby’s sibling chest, having a snuggle.

Why is this encouraged? Well besides from it being squishy and delicious, research has found that there are life-altering changes that happen for Mums’, Dads’ and babies when they share a cuddle.

Your love hormone, Oxytocin, the hormone that comes out and says ‘hey’ when you’re feeling safe (think sex, contractions, breastfeeding, smooching), is released, helping with bonding and attachment.
Skin-to-skin is particularly great for Dads and partners to participate in. Whilst the Mums are having that post-birth heavenly shower or cup of tea, partners whip off their shirts, and love on their baby, getting all the loved up feels!
Tip: Ask for a warm blanket from the warmer, nothing better than a toasty snuggle.

If you’re planning on breastfeeding your baby, skin-to-skin is a wonderful way to start your breastfeeding journey. Breastfeeding is promoted by giving your baby easy access to its new food source and the time to root around and explore what they’ve got to do. They also are able to smoosh their smell all over your chest, making their mark on their new territory.

Skin-to-skin also helps reduce a baby’s stress hormone (cortisol). Your baby has been listening to your heartbeat from the inside for 9 months, so what could be better for your Bub to transition to the world than them snuggling up on your warm chest, listening to your heartbeat? Just writing this makes me think of a relaxed snuggle bunny all curled up on their mama’s chest, blissed out and loving life on the outside. Winning!!

Skin-to-skin helps to regulate a baby’s temperature, heart rate and their blood sugar levels. As midwives we want babies to be being pink, warm and sweet.  Skin-to-skin is a major contributing factor in helping babies to be pink (well perfused – good oxygen levels, good heart rate etc.) warm (normal temperature) and sweet (good blood sugar levels).

Skin-to-skin also does wonderful things to the mamas body, too, but we’ll delve into this in another post.

Keep in mind, if skin-to-skin doesn’t happen immediately at birth, for whatever reason, getting your baby to your chest, or your partners chest as soon as it is possible, still has benefits and is a worthwhile exercise. Plus it feels pretty great, too!

Skin-to-skin is happening more and more, and in some hospitals becoming part of their policies/ highly encouraged now for caesarean section births, so make sure if you want it, that you remind the theatre staff of your wishes.
For the emergency caesar mamas, or the mamas that don’t particularly want their baby immediately on their chest (you might be unwell, nauseous, vomiting etc, and not wanting to in that very moment), this can be a great opportunity for partners to have the first cuddle. I’ve seen many parents in the recovery of theatres taking off their tops and having that delish moment with their new bub. Swooooon!!!!

Remember skin-to-skin isn’t just important when Bub is minutes, hours or a few days old, it is encouraged as much and as often as you want, for as long as you want.

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Photo from Instagram – @melissajeanbabies
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Photos from Instagram – @melissajeanbabies

 

 

Feature image also by the talented @melissajeanbabies. Check out her piccies – she’s amazing!

Perineal Massage

Step-step guide on how to perform perineal massage and the do’s and don’ts.

This won’t be everyones cup of tea, but it’s worth reading about, exploring the concept and discussing with your midwife or obstetrician.

I’ve made an easy to follow brochure below to download:

Winnie Wagtail – Perineal Massage Brochure

Midwife to Mama – my birth story

The story of the day/night/morning I became a Mama

So many of you have shared your birth stories with me, and I’ve been blessed and honoured to have witnessed many strong women and their families become mamas and parents – so it seemed like a no brainer that I would one day share my journey in becoming a mama with you guys, and what a journey it was!

When thinking back chronologically on the two day saga I couldn’t have imagined the rollercoaster of twists and turns that were ahead for me. I did know this was a possibility heading in, which definitely made it easier mentally, but boy was it looooong. And yet, looking back, I’d say I have an amazingly positive birth story, and loved the wild ride it took to meet Syd.

TUESDAY FEBRUARY 20, 2018

40 weeks and 5 days in the throws of a February heatwave, a woman can only handle so much thigh chafe before shit starts getting real (TMI?). I’d had a couple of stretch and sweeps, was 3cm dilated and over it! I booked in for some labour inducing acupuncture with a fabulous woman in Brisbane (if you want her details, DM me on Insty), and a few hours later started feeling niggles.

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the day before labour began

That afternoon I started having regular, but not strong, tightenings lasting 50 seconds straight off the bat. I could talk, walk and smile through them so I did my best to ignore them and we went for our regular 9pm walk (to beat the heat!).

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When I got home they ramped up. The were 3 minutely, lasting 50 seconds and I had lots of back ache (munchkin was direct OP, meaning his spine was on my spine, not ideal). My midwife was kept in the loop and the plan was to call when I was ready to come in to be reassessed etc…..

WEDNESDAY 21st FEBRUARY, 2018

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6am and pretty excited!

4am rolled around, I hadn’t slept and I was ready for either some pain relief, a good ol’ bath, or something! I was assessed at 6am in the Birth Centre at RBWH and was STILL 3cm and effaced (kill me), his head was very low (good!). My contractions had not increased in strength but were lasting a good length and still 2-3 minutely, so we decided to break my waters and get this show on the road.

It worked a treat – contractions stayed consistent in timing and length, and improved in strength.

I laboured in the shower for two hours ( and smashed two bananas) and loved the water on my back. Sitting on the ball and bouncing away under the water was my JAM! To spice things up and keep things moving along (or I hoped would) I laboured on the birth mat, bean bag, used the TENS machine I had hired and the Gas and Air to good effect. Throughout labouring, my Calmbirth breathing that had been a big part of my later pregnancy daily routine was EVERYTHING. I didn’t see it as a coping mechanism in the end and more of a necessity in getting the job (having a baby!) done!

Being reassessed that afternoon, I was 4cm, Bub was still direct OP and his head had started to swell (this is called caput). He was super happy in there, going off his heart rate, so we moved across to the Birth Suite and I got an epidural (I was 6cm by this point) and planned to have a caesarean in the coming hours.

I surprisingly wasn’t disappointed by this plan. I thought I would’ve been, but I wasn’t. When you’re in the moment, labouring away, you realise that birth doesn’t discriminate, you can only control so much, and you really just need to go with the flow.

The epidural was a God send for me. It allowed me to relax, take a second and relax my body for a bit. It also was perfectly timed for Married at First Sight (see top right pic – shameful, I know…to my defence, Raoul loved it more than I did).

The birth suite was having one of those mental nights when all babies decide to kick a stink and all want out, so our caesarean kept getting bumped for Bubs’ that warranted a faster exit.

I was reassessed maybe an hour before we went for the caesar and was 6-7cm, he was still around the wrong way and the plan for the caesar was still in place.

THURSDAY FEBRUARY 22, 2018

Midnight came around and it was our turn  – Raoul got into his scrubs (the most animated I’d seen him in a few hours, I think he was fantasising Greys Anatomy style) and we were off.

My epidural was topped up in the anaesthetic bay before entering theatres and then we moved in, and I was transferred (I remember feeling it was more a ‘heave’ ‘ho’ type situation) to the operating table. I remember wanting Raoul and being nervous. Nervous excited, but nervous.

The clip that had been attached to our baby’s head (called a fetal scalp electrode – helps to monitor the baby’s heart rate accurately when they’re on the inside) was being removed by the registrar that was to perform my caesar.
She was quiet and then said, “do you want the good news or the bad news?”

I said bad news. She responded “the bad news is that we’ve just topped up your epidural, the good news is that you’re 9cm and your baby is lower and in an OA position” (this is a perfect pozzy!). I was then asked “what do you want to do? You’re prepped for a caesar, so you can still have the caesarean now if you want it….or….if you want to try for a vaginal birth I will support you in that decision…it’s up to you. I can’t guarantee that you won’t be back here in a few hours, but if you want to give it a go, I’ll support that”. – What a legend Doctor right there, yeah? Looking back I’m still so amazed and grateful that I had a Registrar on that night that was so woman-centred (it would’ve been 1000 times easier for her to have just done the caesar, I would’ve never been the wiser). I’m forever grateful to her.

I was swirling. I remember just wanting Raoul to make the decision for me. I wanted the caesarean because I was over it and wanted to meet our baby, and had mentally seen the finish line, but I also wanted the natural birth…for the recovery, for the babies of the future etc.

Raoul came into the room, beaming like a cheshire cat in his scrub hat, and I broke the latest news. He smiled and said, “the ideal was for a natural birth, let’s give it a go- I’ll support you if you want to go for it”. He made it sound simple, and easy to process, and he was right, we did want it. So we gave it a go.

I waited 50 mins on the table in theatres for the epidural block to come down to a safe level to leave theatres, to then spend 1.5hours in recovery being monitored further.

By 3am we were being wheeled back to Birth Suite and I started to vomit – fully dilated!

They gave me an hour for passive descent (meaning just keep doing what you’re doing, no directed pushing etc., and let baby’s head come down low enough that I then had the urge to push).

My epidural had in the meantime stopped working. Now from a midwife’s perspective, this is perfect timing to regain sensation so you can feel where to channel your energy when pushing and being able to listen to your body. I didn’t feel this way at all!!! I was furious!!! I felt I had been able to handle the ‘pain’ throughout the day well, working my way up with pain relief options. To go from 0-100000 on the pain scale didn’t seem fair and it was a real mind-fuck for me.

The anaesthetist came back but no luck. So with the epidural in situ, I was standing next to the bed and pushing upright – it definitely wasn’t working!

This is going to sounds horrif as a midwife, but I just wanted to get Bub low enough for the vacuum birth. I was beyond exhausted and ready to meet him. My midwife in the following days said I did exactly that, that I got him low enough and then demanded a vacuum (what a nightmare I would’ve been to look after!)

I did end up having a vacuum, and little Syd born at 5:16am. I’d cooked up quite the temperature at 38.6, and Syd was 38.8 so he went straight off to the nursery after a very quick little snuggle.

A few hours later, after a shower, I met him again, and he had a feed.

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Cooked him up with a temp, Syd went to special care for a few hours, skin-to-skin and first feed here

We left hospital 2 days later.

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Leaving with Syd Vincent – February 24th

It was an eventful few days but looking back I feel so incredibly lucky to have had the information, the preparation and the support to head into the unknown that is birth.
We all just want the best outcome possible at the end of the day.
My ideals changed so quickly in the moment – and I was okay with that. However I stand by my original ethos that the best birth plan is no birth plan at all and rather an informed pregnancy to make the best decisions you can in the moment. In the end, that’s what we did, and whether I’d had the caesar or not, I was happy that I had given it my all, and that’s all you really can do at the end of the day.

To that doctor – I have met woman-centred medical staff over the years, but never have I felt I’ve seen one so in the woman’s corner. Thankyou. You literally have changed my birth journey moving forward.

Raoul was also a champ – he gave a cracker massage, never wavered in support and knew exactly what to say at the right time. A+ !

Third Time Lucky

What I learnt from two miscarriages and what midwifery qualifications can’t teach you…

It’s funny being on the other side, especially after a few false starts. Two, to be exact. Miscarriage is something that, being a midwife, I  should’ve been more realistic about, especially with 1 in 4 pregnancies resulting in miscarriage, but I thought, 26 and healthy, there would be no reason to consider the gloomy side of things.
Falling pregnant for us, was easy! 3 cycles = 3 pregnancies, which we were and are very grateful for, but getting the little rugrats to stick was the hard part for us.

Recurrent miscarriage is classified as 3 or more miscarriages, so a lot of the time investigations start after the third miscarriage…but being an impatient Gen Y’er, and lucky enough to be working with, and surrounded by midwives and obstetricians to help with the investigations, I got straight to it to see what was going on/if anything was going on…

One consult with a colleague, 18 tubes of blood later and I had been tested for every weird and wonderful anomaly+chromosomal testing you could consider, I got an ultrasound,my husband got sperm+chromosomal testing, and 3 months later when the results returned, everything was perfectly normal. This was good, but was frustrating – I was almost of the mentality, if something had been there, we could work at it and fix it, but nothing showed up….as a lot of the time it does. We put it down to environment.

I’m a stress-head and love working and keeping busy. I was working a job that required me being on call, working long shifts and keeping bizarro hours – all in all not really looking after myself. My healthy lifestyle choices would fly out the window because the reformer pilates class I was booked into, or the trip to the gym, was now kiboshed by a trip into the hospital, and once I’d returned I was buggered and we’d order takeaway.

When I was newly pregnant, the first time, I pulled a few all nighters at the hospital, and we were particularly busy. I didn’t eat any food/drink minimal water for each of the shifts and we didn’t have breaks…not that I think this was the reason for what eventuated, but it just goes to again reinforce the pace at which I was moving and the fact that I wasn’t putting myself or my pregnancy first.
A couple of days later, I started a new role at the same hospital I had been working at, and as the heaven’s would have it, my first week on the job, I had a miscarriage. Not wanting to take anytime off (group practices rely heavily on being a team player…and I would be buggered if I was going to let the team down week 1!) I worked the whole way through….and did the second time as well, this time pulling a 12 hour shift, doing home postnatal visits, returning to go to the loo and instead ended up running for emergency caesarean… craziness. I ended up in hospital that night with falling blood levels and an operation at 3am. Stupid. Stupid. Stupid.

What’s the point to this article? A lesson of hindsight and how you can learn from my stupid ways.

Things I wish I had done sooner:

Prioritised myself and my health. Working within a big organisation you can be chewed up and spat out without even really noticing it. If you need a day off, you need a day off. Take it. Don’t be a martyr. I’m getting better at this. Third time around, I knew I was pregnant by 3.5 weeks (when I started vomiting all the time)…so I took the week off and veged on the couch watching movies, and as luck would have it (if you call moving interstate and packing up a house lucky when you’re 5 weeks pregnant) I was finishing up in this role a fortnight later. So I didn’t/haven’t looked for midwifery jobs in Brissie yet, I’m studying to educate Calmbirth for the moment and doing some freelance stuff.

Find a good GP. Going to whomever that was available at the local bulk-billed place when you need the quick medical certificate or script had always served me well, but not having a regular GP when it came time to pregnancy related stuff kinda screwed me. Having to show up to get your bloods taken to confirm falling HCG levels mid miscarriages by rando Dr’s that have no bedside manner and answer questions like “do you have any kids?” rather than “are you okay?” or “this sucks” was a kick in the head, twice… Go find one you like, and stick with them.

If you’ve had a couple of miscarriages and you’re wanting to investigate sooner that what a GP would normally recommend investigating or write a referral for, do it if it’s going to give you piece of mind. Even though it was third time lucky for us, just knowing that there was nothing showing up on paper was enough of a confidence booster a few months later to try again. Worth every penny! Be “difficult” and demand it. No harm in investigating, if this is what’ll keep you sane.

 

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Baking until Feb 2018

 

Pelvic Floor Exercises; no activewear required!

You don’t need activewear or a gym membership to strengthen these bad boys, just a little discipline. Here’s the 411 on why as women; before, during and post babies we should be activating our pelvic floor.

Pelvic floor exercises are something that, as women, we’re told about over and over again, but are we doing these quick and uncomfortable exercises as often as we should be…i.e. everyday?
I know I don’t, and dare I speak on behalf of women, I’m sure the majority of us aren’t doing them as often as we should be. A study conducted in the UK has shown that 66% of women didn’t know where their pelvic floor was and only 40% doing their pelvic floor exercises on a regular basis – not great stats when I’m sure 100% of us do not want to be urinary and/or faecally incontinent in the long run!

So here’s a quick 411 on all things pelvic floor and why they are important for women pre-baby, during pregnancy and post baby.

What is the pelvic floor?

Think of your pelvic floor as a sling of muscles that support the uterus, bladder and bowel. Everything that comes out from down below passes through the pelvic floor. These sling-like muscles attach at the front to your pubic bone and at the back to your tail bone, from the base of your pelvis.

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How do I do a kegel correctly?

To understand the muscles involved in pelvic floor exercises imagine needing to do a wee but not being near the toilet…that initial squeeze is the activation of your pelvic floor. How to do your pelvic floor exercises, see link below:

Continence Foundation of Australia

The Royal Women’s Hospital

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via pilatespod.co.uk
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via mutusystem.com

What’s the point pre-baby?

  • Provides bladder and sphincter control
  • Facilitates a strong foundation for when you do have a baby (think bowling ball sitting on your bladder…), to help minimise urinary incontinence
  • Can improve orgasms and sexual pleasure

What’s the point during pregnancy?

During pregnancy, the hormone progesterone softens and relaxes the muscles and ligaments within your body, enabling it to help bub manoeuvre its way through the pelvis and birth canal.

This progesterone also slows other things down in your body and a common problem during pregnancy is constipation, so drink lots or water, stay active and embrace a fibre-rich diet.

During labour and birth the pressure of bearing down and pushing may stretch and weaken the pelvic floor, so having the foundation of a strong pelvic floor can benefit the efficacy of pushing. It’s also not a bad idea to look into birthing positions, as birthing in an upright position can increase pelvic diameter by 30% …working with gravity…making more room for bub (read our article on birthing positions here)

The benefits of doing your pelvic floor exercises (excerpt via huggies.com) :

  • The risk of uterine or bladder prolapse is reduced
  • Pregnancy, delivery and recovery time can be improved
  • Post-partum discomfort from perineal swelling and haemorrhoids is reduced
  • Perineal tearing and/or need for an episiotomy is reduced
  • Urinary incontinence/leakage during pregnancy and after delivery is reduced
  • A toned pelvic floor leads to more complete emptying of the bladder and bowel
  • Helps to avoid stress incontinence after delivery – small amounts of urine leakage when laughing, sneezing, coughing or lifting something heavy

 

How do I regain strength post baby, and when should I start doing my pelvic floor exercises?

Start doing those pelvic floor exercises ASAP. Some women may find in the days post birth that doing their exercises laying down is easier and they are able to engage the right muscles more easily. Give it a go!

Before baby and during pregnancy your pelvic floor strength will have been more toned and therefore your exercises will have been stronger and longer in duration. In the early days post birth it’s important to work up to it. Aim for a few seconds each day for the first week, and build up to it slowly.

Tools to help with pelvic floor instability and incontinence

If you’re one of those people that need a gadget to motivate you to do exercise, here are few to investigate:

http://www.epi-no.com.au/

http://www.kgoal.com.au/

 

 

 

 

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